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Reliability of the "Clinical Tibiofibular Line" Technique for Open Syndesmosis Reduction Assessment
Anthony A Pollizzi1,2,3,4,5, Daniel C Herman1,2,3,4,5, Gregory C Berlet1,2,3,4,5
1College of Medicine, University of Florida, Gainesville, Florida (AAP).
Background:
When intraoperative computed tomography (CT) is unavailable, open syndesmosis assessment is a universally available, safe alternative that is more accurate than radiographic assessment. However, it has a documented malreduction rate of up to 16%. This may be improved upon with a validated technique for assessing the accuracy of open syndesmosis reductions. The "tibiofibular line" (TFL) is a CT-based technique found to be sensitive for malreduction. The purpose of this study was to assess the feasibility of adapting the CT-TFL method into a reliable intraoperative open technique by refining the methodology of previous work exploring the clinical TFL technique.
Methods:
Three observers were instructed to clinically simulate the TFL on cadaveric lower limbs. For each specimen, observers repeated and recorded 3 clinical TFL measurements for each of 4 measurement series representing different degrees of fibula reduction. Intraclass correlation was used to assess intra- and interobserver reliabilities.
Results:
Mean intraobserver reliability was .88. Mean interobserver reliability was .75. Both intra- and interobserver reliabilities were highest for anatomic syndesmosis reduction.
Conclusion:
The findings of excellent to near perfect intraobserver and good to excellent interobserver reliability indicate the feasibility of translating the CT-TFL into a reliable open technique.
Levels Of Evidence:
Level III: Diagnostic study.
